Last week was National Folate Awareness Week.  While this post may be a little late, it is never too late to remind women of reproductive age of the importance of taking supplemental folic acid.

Folic Acid Reduces the Risk of Birth Defects

Folic acid is a B-vitamin needed for proper cell growth and can be found in many multivitamins, as well as many food sources, such as lentils, dried beans and peas, and dark green vegetables.  Since 1998, the Food and Drug Administration has required the addition of folic acid to many enriched breads and cereals in order to increase the amount of folic acid in our diets.

The CDC, the U.S. Public Health Service and the American College of Obstetricians and Gynecologists (ACOG), recommends that every woman of reproductive age get 400 micrograms (400 mcg) or 0.4 milligrams of folic acid every day. Most multivitamins contain 400 micrograms or 0.4 milligrams of folic acid. Most prenatal vitamins have approximately 800 micrograms or 0.8 milligrams of folic acid.

By taking the recommended dosage of folic acid daily, women will reduce the risk of neural tube defects by 50% – 70%. 

While the USPSTF focuses primarily on risk for neural tube defects, other studies indicate that periconceptual use of folic acid reduces risk for other congenital malformations, including oral clefts.  In addition, folic acid supplementation has been associated with clinically significant reductions in risk of miscarriage, stillbirth, preterm birth, and neonatal mortality.

Folic Acid Reduces the Risk of Autism Spectrum Disorders 

In addition, women who take folic acid supplements are less likely to give birth to a child with an autism spectrum disorder.  The benefits of folic acid were observed in women taking folic acid before pregnancy.  The risk of having a child with autism was reduced by 40% among women who had taken folic acid supplements from four weeks prior to conception and continuing eight weeks into the pregnancy.

Why Should Women Take Folic Acid Before They Attempt to Conceive?

It is important for all women of child-bearing age to take this recommended daily dosage of folic acid even if they are not planning pregnancy because folic acid is needed in the first weeks of pregnancy, even before a woman may know she’s pregnant. Because 50% of all pregnancies are unplanned, any woman who could potentially become pregnant should take folic acid daily.  

In addition, using folic acid for at least one month before conception has been associated with decreased risk for autism spectrum disorders.  In contrast, starting folic acid after conception may not provide the greatest benefit.

The Bottom Line

The CDC, the U.S. Public Health Service and the American College of Obstetricians and Gynecologists (ACOG), urge every woman who could become pregnant to take at least 400 micrograms (400 mcg) or 0.4 milligrams of folic acid every day. Most multivitamins contain 400 micrograms or 0.4 milligrams of folic acid. Most prenatal vitamins have approximately 800 micrograms or 0.8 milligrams of folic acid.  Some women are more likely to be folate deficient and may need higher doses or alternate forms of folate supplementation.

 

Ruta Nonacs, MD PhD